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® PERMIT APPLICATIOilibi <br /> BUILDINOMECHANICAL / PLUMBING / SIGN , .SPRINKLER/ DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: t 2i(b \ ,1' " otivt , " PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: C ;1/0 TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: \jbli,(t ci7V ( b\J 'i Ye 'f1 ) 1mt. <br /> ►�pl (�CONTRACTOR ADDRESS: ' ``STRRE,ET` DO V, -' 20 �/V l/• -we <br /> CONTRACTOR <br /> .. .01111 <br /> STATE Krx, . ZIP 0 <br /> (Th <br /> //�� <br /> �� Pr <br /> CONTRACTOR PHONE: C1'1 I• vN CO• 0 62o CONTRACTOR EMAIL: 1 <br /> CONTRACTOR LICENSE#(REQUIRED) V Q (SCi t0P CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)e i � l I <br /> PRIMARY CONTACT:kit❑ OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: `/DI1 , SD `o 1�Z1 20 / '`PiA �,/I� 1 CONTACT EMAIL: C_��I . 9 VW rtP, t I © J�1 , (Q'YVi <br /> BUILDING INFORMATION <br /> Existing Use of Building: Contract Price of Work:$ * bell d°C <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure <br /> Type of Project: CI New ❑Addition ❑Remodel CI Repair DTI. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: kOdI'`� io i/ Y O'11 SS-6V1�J (f115\--e- ' <br /> 1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): '\Uy),-- DV <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER 1 SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm th . forma' ontained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ail/14\ <br /> 1 Y 910 IO 1 120 1 1 PE MI �' ��� <br /> Owner/Authorized Agent Signature Date (Revised 4/15/2019) 1l 2- <br />